Physical training for asthma

Abstract

BACKGROUND: People with asthma may show less tolerance to exercise due to worsening asthma symptoms during exercise or other reasons such as deconditioning as a consequence of inactivity. Some may restrict activities as per medical advice or family influence and this might result in reduced physical fitness. Physical training programs aim to improve physical fitness, neuromuscular coordination and self confidence. Subjectively, many people with asthma report that they are symptomatically better when fit, but results from trials have varied and have been difficult to compare because of different designs and training protocols. Also, as exercise can induce asthma, the safety of exercise programmes needs to be considered. OBJECTIVE: To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials. METHODS: Search methods: We searched the Cochrane Airways Group Specialised Register of trials up to January 2013. Selection criteria: We included randomised trials of people over eight years of age with asthma who were randomised to undertake physical training or not. Physical training had to be undertaken for at least 20 minutes, two times a week, over a minimum period of four weeks. Data collection and analysis: Two review authors independently assessed eligibility for inclusion and undertook risk of bias assessment for the included studies. MAIN RESULTS: Twenty-one studies (772 participants) were included in this review with two additional 2012 studies identified as 'awaiting classification'. Physical training was well tolerated with no adverse effects reported. None of the studies mentioned worsening of asthma symptoms following physical training. Physical training showed marked improvement in cardiopulmonary fitness as measured by a statistically and clinically significant increase in maximum oxygen uptake (mean difference (MD) 4.92 mL/kg/min; 95% confidence interval (CI) 3.98 to 5.87; P < 0.00001; 8 studies on 267 participants); however, no statistically significant effects were observed for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), minute ventilation at maximal exercise (VEmax) or peak expiratory flow rate (PEFR). Meta-analysis of four studies detected a statistically significant increase in maximum heart rate, and following a sensitivity analysis and removal of two studies significance was maintained (MD 3.67 bpm; 95% CI 0.90 to 3.44; P = 0.01). Although there were insufficient data to pool results due to diverse reporting tools, there was some evidence to suggest that physical training may have positive effects on healthrelated quality of life, with four of five studies producing a statistically and clinically significant benefit. AUTHORS' CONCLUSIONS: This review demonstrated that physical training showed significant improvement in maximum oxygen uptake, though no effects were observed in other measures of pulmonary function. Physical training was well tolerated among people with asthma in the inc...

Sex Differences in Athletes With Asthma and Exercise-Induced Bronchoconstriction: Future Directions

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Avaliação do nível de atividade física diária e fatores preditivos em crianças asmáticas da cidade de São Paulo

“…As atividades aeróbicas tais como caminhada, natação, ciclismo, corrida, ginástica e danças têm sido indicadas para manter o condicionamento físico quando realizada numa frequência de 3 a 5 vezes por semana (Lucas;. Os benefícios do treinamento físico nesses pacientes estão sendo cada vez mais estudados e alguns já são bem estabelecidos como a melhora do condicionamento físico e a redução da dispneia durante o exercício (Vahlkvist et al, 2010;Chandratilleke et al, 2012). Nesse sentido, outros estudos sugerem que a prática regular de exercício físico reduz a broncoconstrição induzida pelo exercício (Fanelli et al, 2007), a hiperresponsividade brônquica (Shaaban et al, 2007), o uso do corticoide (Faneli et al, 2007), o risco de exacerbação da doença (Garcia-Aymerich et al, 2009), a inflamação da via aérea (Mendes et al, 2011) e a melhora dos fatores de saúde relacionados à qualidade de vida (Mendes et al, 2010).…”

Efeito do exercício físico na inflamação pulmonar e na resposta imunológica sistêmica em pacientes com asma persistente moderada ou grave

“…Neste sentido, já foi demonstrado que mesmo em pacientes em tratamento clínico-medicamentoso otimizado, o treinamento físico melhora a capacidade aeróbia máxima (Ram, 2009), FSRQV (Mendes et al, 2010) e o controle clínico (Dogra et al, 2011), bem como reduz os sintomas de asma (Mendes et al, 1011) e o broncoespasmo induzido pelo exercício (Fanelli et al, 2007). Apesar destas evidências, uma revisão sistemática e meta-análise recente demonstrou que os únicos efeitos concretos do treinamento físico na asma são o aumento da capacidade aeróbia máxima (VO 2 máx) e manutenção da função pulmonar (Chandratilleke et al, 2012). Devido a escassez de trabalhos e do uso de diferentes ferramentas os autores concluíram que não existem dados suficientes para realizar uma meta-análise dos efeitos do treinamento físico sobre os FSRQV e controle clínico, dois dos principais objetivos no tratamento da asma.…”